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Abstract
This
paper
takes
as
its
starting
point
Peter
Sedgwick’s
Psycho
Politics
(1982)
in
which
he
called
for
“more
and
better”
psychiatric
treatment
in
response
to
significant
“anti-psychiatry”
movements
by
patients,
carers
and
clinicians.
In
the
30
years
since
he
wrote,
mental
health
services
have
been
dramatically
reshaped
by
neoliberalism
—
where
patients
are
“consumers”,
the
state
demands
greater
coercion
to
control
“risk”,
and
Big
Pharma
has
created
massive
new
markets
for
drug
treatments
—
while
public
resources
have
been
eroded.
Equally,
campaigns
around
psychiatric
treatment
have
often
been
delimited
by
and
adapted
to
hegemonic
neoliberal
frameworks.
Does
Sedgwick
offer
us
the
basis
for
challenging
these
reverses
and
building
resistance
that
can
provide
renewed
hope?
And
how
does
his
approach
square
with
arguments
that,
if
done
right,
modern,
scientific
psychiatry
can
itself
promise
liberation?
Introduction
Over
the
last
30
years,
mental
health
and
illness
have
been
dramatically
reshaped
by
neoliberalism.
Patients
have
become
“consumers”,
the
state
demands
greater
coercion
to
control
“risk”,
and
pharmaceutical
companies
have
created
massive
new
markets
for
their
drugs.
Publicly
funded
services
have
withered,
with
market
principles
introduced
to
drive
down
costs.
At
the
same
time,
patient
campaigns
around
psychiatric
treatment
have
often
been
delimited
by
and
adapted
to
hegemonic
neoliberal
frameworks
under
the
rubric
of
“consumer
empowerment”.
Within
psychiatric
science
itself,
the
biomedical
model
is
more
dominant
than
ever.
It
is
a
far
cry
from
the
1960s
and
1970s,
when
anti-‐psychiatric
critiques
and
movements
seemed
to
have
mainstream
psychiatry
on
the
ropes,
attacked
for
its
bad
science,
ineffective
treatments
and
repressive
powers.
Yet,
despite
the
renewed
rise
of
critical
voices
both
within
and
outside
its
ranks,
the
psychiatric
establishment
prevails,
having
successfully
seen
off
those
powerful
challenges.
This
paper
will
trace
these
developments
by
examining
the
nature,
strengths
and
weaknesses
of
the
anti-‐psychiatry
movements
of
the
past
through
the
theoretical
framework
developed
by
Peter
Sedgwick
in
his
book
Psycho
Politics
(1982)
and
elsewhere,
in
which
he
demanded
“more
and
better
mental
hospitals,
more
and
better
doctors
and
nurses”.
It
will
use
Sedgwick’s
insights
to
show
how
anti-‐psychiatric
politics
were
vulnerable
to
neutralisation
or
co-‐option
in
the
turn
to
neoliberal
capitalism,
in
particular
in
its
effects
on
mental
health
treatments.
Finally,
it
will
suggest
that
his
anti-‐
capitalist
critique
is
a
necessary
basis
for
any
new
critical
praxis
that
challenges
not
just
mainstream
psychiatry’s
flaws
but
the
social
order
from
which
they
emerge.
Anti-‐psychiatric
critiques
&
movements
Anti-‐psychiatric
critiques
and
movements,
while
often
seen
by
mainstream
psychiatrists
as
a
monolithic
threat,
were
always
marked
by
considerable
heterogeneity.
Nevertheless,
it
is
possible
to
outline
three
basic
themes
that
cohered
them:
1. The
quality
of
the
“science”
of
psychiatry
when
compared
with
medicine
in
general
2. The
repressive
nature
of
psychiatric
practice,
with
its
ability
to
rob
patients
of
their
individual
rights
through
mechanisms
such
as
detention
and
forcible
treatment
3. The
value-‐laden
nature
of
psychiatric
diagnosis
that
turned
deviancy
from
mainstream
norms
into
an
undefinable
entity
called
“mental
illness”.
1
These
themes
can
be
seen
in
the
work
of
four
key
thinkers,
whose
work
remains
a
touchstone
for
anti-‐psychiatric
critiques
today.
Firstly,
writing
from
the
late
1950s,
North
American
sociologist
Erving
Goffman
developed
a
trenchant
ethnographic
examination
of
psychiatric
hospitals,
with
their
often
brutal
and
ineffective
treatments
and
tendency
to
render
patients
“dull
and
inconspicuous”
(Goffman
1961).
Secondly,
in
the
1960s
Scottish
psychiatrist
and
psychotherapist
R.D.
Laing
argued
that
schizophrenia
resulted
from
impossible
“binds”
people
were
put
in
by
their
families
and
society,
and
therefore
it
was
really
society
and
not
the
patient
that
was
pathological
(Laing
1964).
Also
writing
in
the
1960s,
Hungarian-‐American
psychiatrist
Thomas
Szasz
claimed
that
mental
illness
was
a
“myth”
because
unlike
physical
illness
there
were
no
“anatomical
and
genetic”
contexts
to
judging
someone
mentally
ill,
only
“social
and
ethical”
ones.
He
hit
out
at
how
psychiatrists
could
deprive
people
of
their
liberties
simply
by
bestowing
a
spurious
diagnosis
(Szasz
1960).
And
finally,
French
philosophe
Michel
Foucault,
in
a
more
complex
line
of
reasoning,
posited
that
concepts
of
mental
health
and
illness
were
purely
social-‐historical
constructs
that
shifted
and
changed
over
time
but
always
played
the
same
role
in
upholding
power
relations.
That
is,
the
asylum
and
the
psychoanalyst’s
couch
were
equally
just
parts
of
systems
of
repression
and
control
(Foucault
2001).
Anti-‐psychiatric
ideas
were
often
seen
as
a
radical,
liberatory
antidote
to
a
reactionary
mental
health
system.
Their
popularity
was
tied
up
with
counter-‐cultural
and
social
movement
activity
erupting
across
Western
nations
at
the
time.
These
movements’
calls
for
personal
and
social
liberation
within
a
nascent
anti-‐systemic
outlook
meant
that
society’s
treatment
of
deviant
behaviour
soon
attracted
their
attention.
New
Left
Review
ran
some
of
Laing’s
(1964)
writings
and
its
editors
waxed
lyrical
about
his
revolutionary
import.
Moreover,
anti-‐psychiatry
ideas
were
not
just
disembodied
phenomena
but
were
taken
up
by
real
movements
of
psychiatric
patients,
their
friends
and
relatives,
and
at
times
reforming
clinicians.
As
one
history
of
such
movements
in
the
United
States
points
out
(Tomes
2006:
722-‐3),
in
the
period
1950-‐70
deinstitutionalisation
led
to
advocacy
that
was
still
mainly
led
by
clinicians
but
from
around
1970
a
psychiatric
“survivor”
movement
developed
in
the
setting
of
radical
social
movements
of
the
1960s,
looking
to
patients
themselves
to
build
a
new
type
of
mental
health
system
based
on
self-‐
empowerment.
McLean
notes,
“Intellectually,
the
movement
was
nurtured
by
the
consciousness
raising
of
the
feminist
movement,
the
societal
critiques
of
the
radical
therapists,
the
labelling
arguments
of
the
gay
liberation
movement,
and
the
philosophies
of
self-‐help
movements”
(2000:
823-‐4).
In
the
spirit
of
the
times,
one
of
the
first
patient
1
As
McLean
(2000)
summarises
it:
“The
movement
was
overwhelmingly
antipsychiatry,
anti–medical
model,
and
opposed
to
forced
treatment
and
involuntary
commitment.
Participants
located
mental
illness
not
in
individual
impairments
but
in
oppressive
social
conditions.”
groups
to
spring
up
in
the
United
States
called
itself
the
Psychiatric
Inmates
Liberation
Movement
(McLean
2000:
822).
Very
soon
the
anti-‐authoritarian
bent
of
some
activists
led
them
to
break
ties
even
with
sympathetic
clinicians.
In
response
to
this
frontal
assault,
the
mainstream
of
psychiatry
felt
under
siege.
At
first
it
tried
to
ignore
it,
but
by
the
1970s
was
moving
to
clean
up
its
act.
Yet
it
managed
to
do
so
in
a
way
that
rehabilitated
much
of
what
was
being
attacked
in
the
first
place.
How
did
such
an
apparently
radical
critique
get
subverted
so
thoroughly?
Conclusion
Although
he
published
Psycho
Politics
at
the
very
start
of
the
neoliberal
era,
Peter
Sedgwick
was
able
to
develop
a
critique
of
existing
psychiatry
that
could
serve
as
a
useful
approach
to
resisting
the
logic
of
neoliberal
transformations
of
mental
health
and
illness.
He
would
not
have
been
surprised
by
mainstream
psychiatry’s
ability
to
claim
it
now
stood
on
firm
scientific
footing
with
the
positivist,
narrowly
biomedical
counter-‐
revolution
ushered
in
with
the
DSM-‐III.
Neither
would
he
have
been
shocked
to
see
individual
rights
agendas
moulded
into
safe
channels
through
consumer
empowerment
strategies,
while
authoritarian
policies
gradually
bubbled
back
into
view.
And
he
would
have
rejected
the
naïve
hope
that
the
explosion
of
medical
diagnoses
for
all
kinds
of
human
distress
could
be
resolved
through
interventions
(psychiatric
or
anti-‐psychiatric)
divorced
from
a
social
substrate.
Despite
the
difficulties
involved
in
creating
such
unity,
Sedgwick
always
highlighted
the
need
for
genuine
cooperation
from
below
between
patients
and
clinicians,
which
would
naturally
mean
having
to
challenge
the
power
relations
structuring
existing
services.
His
suggestion
that
we
fight
for
serious
reforms
and
improvements
in
the
existing
system
was
not
a
lowering
of
horizons
but
an
unavoidable
building
block
for
genuinely
collective
alternatives
to
the
capitalist
organisation
of
mental
health
and
illness.
His
method,
then,
was
not
about
a
question
of
psychiatry
versus
anti-‐psychiatry,
but
of
addressing
mental
health
illness
in
the
context
of
projects
for
social
transformation.
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